The effect of interventions to alter the consultation length of family physicians: a systematic review.

BACKGROUND: Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average length of consultation differs, however, these differences may be due to self selection. AIM: To assess the effectiveness and cost effectiveness of interventions to alter primary care physicians' consultation length. DESIGN OF STUDY: Systematic review with narrative analysis.
METHOD: Data sources included Medline, EMBASE, the Cochrane Controlled Trials Register and Effective Practice and Organisation of Care Group specialised register, the NHS National Research Register and author contacts. To be eligible, studies had to be controlled trials. They had to evaluate interventions to alter the consultation length of primary care physicians, and provide objectively measured process or outcome data. Data were extracted independently using agreed criteria and disagreements resolved by discussion.
RESULTS: Six articles describing four trials were included. All took place in the UK and tested short term changes in the time allocated to each patient, and all had methodological weaknesses, particularly due to non random allocation of patients. Altering appointment length resulted in modest changes in average consultation length. There were no consistent differences in problem recognition, examination, prescribing, referral or investigation rates. There was some evidence that blood pressure was checked more frequently and smoking discussed more often when more time was available. None of the interventions were associated with differences in patient satisfaction. No trials examined cost effectiveness.
CONCLUSIONS: Our findings do not provide sufficient evidence to support or resist a policy of altering consultation lengths of primary care physicians. Further trials are needed, focussing on health outcomes and cost effectiveness.